Curriculum

The Brigham and Women’s Hospital (BWH)/Boston Children’s Hospital (BCH) Medicine-Pediatrics curriculum is comprehensive and flexible.  The curriculum follows the guidelines outlined by the American Board of Internal Medicine and the American Board of Pediatrics as well as the requirements of the Accreditation Council for Graduate Medical Education.  The program is designed so that residents learn the skills necessary to become exceptional leaders in whatever field they choose, whether it be as a generalist clinician, hospitalist, or subspecialty physician.  The goal of the Med-Peds Residency leadership is to help residents achieve their long-term goals through personalized mentorship.  Over the four years, there are opportunities for residents to tailor the standard curriculum to their own interests and needs, particularly during research and elective time.  There is a wealth of mentors available for residents through these hospitals and the medical school. The program has an official mentoring program as well as individual meetings with the program directors to ensure that housestaff are connected to faculty who will support and guide them in their research and career paths.

As residents progress through the training program, they have a graduated increase in responsibility for the patient care, team leadership, and teaching with supervisory rotations beginning in their second year in both medicine and pediatrics. Interns and residents switch between the departments approximately every three months, the one exception being the first switch between departments, which occurs between July and August. This early first switch is designed to give interns the opportunity to experience pediatrics and medicine settings in the first few months of internship with their categorical counterparts.  This allows for better socialization and incorporation of Med-Peds residents with their colleagues.

The Med-Peds intern experience is 12 months. The first year provides the resident with the core experiences needed to assume supervisory responsibilities in both medicine and pediatrics.  Every intern rotates through essentially the same core experiences in preparation for more supervisory roles in the second, third and fourth years of residency. The curriculum is designed to be "front-loaded" so that interns gain important experience in direct patient care, performing invasive procedures, and becoming comfortable with intensive care, emergency room, and ward protocols. Second, third, and fourth year residents advance their leadership and clinical skills through supervisory rotations, ICU experiences, outpatient block rotations, and electives.

Residents spend most of their time at the home institutions of BWH and BCH, but also train at the affiliated institutions of Faulkner Hospital during medicine rotations and Boston Medical Center during pediatric rotations.  Faulkner Hospital offers exposure to academic, community-based internal medicine to complement the more tertiary/quaternary care of BWH wards.  Boston Medical Center is a city hospital that has been a partner in the Boston Combined Residency Program in Pediatrics for more than 15 years and offers exposure to general pediatrics, emergency medicine, and pediatric and neonatal intensive care. This collaboration offers true educational excellence by combining the culture of a public city hospital with that of a private, sub specialty hospital.

Residents are fully supported and mentored in their individual interests and career development efforts. There are a host of electives available to residents at all four hospitals.  Additionally, residents have the opportunity to spend four months (2 from each department) focusing intensely on research activities in their third and/or fourth year.  Numerous structured domestic and international rotations are available through both residencies, ranging from Shiprock, NM to Lesotho, Haiti, Peru and South Africa.  Residents are also supported in their self-designed rotations abroad.  Residents are eligible to apply for the Global Health Equity Residency available through the Brigham and Women’s Hospital Internal Medicine Residencyas well as the Harvard Humanitarian Initiative.  There is an opportunity to participate in the mentoring and lecture series associated with the Global Child Health Initiative through the BCRP. 

Med-Peds Core Curriculum
All Harvard BWH/BCH Med-Peds residents participate in a four-year Med-Peds Core Curriculum designed to prepare exceptional dual-trained physicians.  This core curriculum, organized by the Med-Peds faculty and chief resident, serves to supplement daily conferences sponsored by the categorical Internal Medicine and Pediatrics programs.  Currently, our core curriculum includes the following events that our residents attend together as a Med-Peds cohort: Med-Peds Academic Half Day, Ambulatory Clinic Conferences, Med-Peds Mentoring Activities,  and Med-Peds Retreats.

Med-Peds Academic Half Day: The cornerstone of the Med-Peds Core Curriculum, taking place once monthly on Friday afternoons.  A new initiative, organized by the Med-Peds Chief Resident, the academic half day covers core topics in both Internal Medicine and Pediatrics, as well as serving as a home for workshops and lectures on mentorship, career development, and quality improvement.  It gives residents experience in teaching by leading and receiving feedback in a small group teaching session.  It also allows residents a forum to discuss their personal research and outside clinical experiences with their peers, and to learn from others.  Of course, we are also very happy for the chance to see each other and catch up!

Crossover Curriculum: These twin mini-curricula that run throughout the year within our affiliated categorical medicine and pediatrics residency programs.  Crossover sessions for internal medicine residents focus on the management of adults with childhood-onset chronic diseases (including pediatric cancer survivorship, sickle cell disease, and other conditions) while those for pediatric residents deal with conditions more commonly seen in adults (including pancreatitis, pulmonary embolism, and others).  All sessions involve master faculty from the other institution as discussants. These programs, the first of their kind, have been popular within the categorical programs and have established a unique educational niche for our program's residents.

Med-Peds Grand Rounds: The Harvard BWH/CHB Med-Peds Program sponsors Med-Peds oriented Grand Rounds in both categorical programs.  

Ambulatory Clinic Conference: Residents discuss selected core outpatient Internal Medicine and Pediatrics topics standardized by both Med-Peds clinic sites.  Both residents and preceptors participate in teaching these pre- or post- clinic sessions each week. 

Retreats: Biannual retreats allow time outside of the hospital to reflect, discuss program development, and play touch football!

Mentoring: The BWH / BCH Med-Peds residency program is committed to the professional development of its trainees.  The Academic Half Day is home to the "mentorship curriculum," which provides residents with lectures on core topics relevant to career development.  Additionally, faculty who are trained in Med-Peds and work in and around Boston lead sessions providing advice on career opportunities, fellowship, and work-life balance by sharing insight into their own career paths.

For more information about the many Med-Peds gatherings and social activities, visit our "Life Outside Residency" link. 

Harvard Brigham/Children’s Med-Peds Curriculum (Typical)

 PGY-1
Medicine
4 weeks GMS (general medicine service)
4 weeks Oncology service
4 weeks Cardiology service
6 weeks AMB (outpatient block) 
2 weeks CCU
2 weeks MICU
2 weeks ER
2 weeks vacation

Pediatrics
4 weeks General Pediatrics 
4 weeks BMC ward (2 weeks nights)
4 weeks Newborn block
4 weeks NICU 
4 weeks Child Development
4 weeks ER (2 wks at BMC)
Vacation 2wks

PGY-2
Medicine
4 weeks elective
4 weeks Cardiology or Oncology or General Medicine
4 weeks Faulkner 
2 weeks Geriatrics
4 weeks AMB (outpatient block)
2 weeks CCU
2 weeks ER
2 weeks Night Team
2 weeks vacation
 
Pediatrics
4 weeks BMC Ward or SSU (short stay unit) 
4 weeks Cardiology
4 weeks GI block
4 weeks Oncology block
4 weeks PICU 
4 weeks Adolescent Medicine
2 weeks vacation

PGY-3
Medicine
4 weeks General Medicine Service
4 weeks Faulkner Ward, Cards or ONC
4 weeks AMB (outpatient)
8 weeks elective
2 weeks Night Team
2 weeks MICU
2 weeks vacation

Pediatrics
4 weeks Intermediate Care Unit / Ward Team Leader
4 week selective in 4 wk block
4 weeks Delivery Room / NICU
4 weeks Advocacy
4 weeks elective with call  (ELN)
2 wks elective call free (ELC)
2 weeks Back-up Call
2 weeks vacation

PGY-4
Medicine
4 weeks Ward
4 weeks MICU
4 weeks AMB (outpatient)
8 weeks elective/research
2 weeks Night Team
2 weeks Senior Consult Resident/Geriatrics
2 weeks vacation

Pediatrics
6 weeks General Pediatrics (2 wks night team)
4 weeks elective call free
8 weeks elective ELN (total of 8 wks of ELN/ELC can be used as research time)
4 weeks ER (BMC)
2 weeks NICU Supervisor 
2weeks vacation

Example Topics

Headline Overview

Placenta accreta occurs when the placenta—the organ that provides nutrients and other support to a developing fetus—attaches too deeply to the uterine wall. This often leads to two major complications: the placenta cannot normally deliver after the baby’s birth, and attempts to remove the placenta can lead to heavy bleeding. This is a serious condition that can cause complications for the baby and mother, especially during the delivery. With supervision by experienced clinicians, however, these complications and risks can be managed effectively.

Placenta Increta and Percreta

Placenta increta and placenta percreta are similar to placenta accreta, but more severe.

  • Placenta increta is a condition where the placenta attaches more firmly to the uterus and becomes embedded in the organ’s muscle wall.
  • Placenta percreta is a condition where placenta attaches itself and grows through the uterus and potentially to the nearby organs (such as the bladder).

Obstetricians seek to make a specific diagnosis of accreta, increta or percreta before delivery using ultrasound and MRI imaging, but this is not always possible.

Headline

Placenta accreta generally has no symptoms. However, placenta previa, which often develops along with accreta, often presents with vaginal bleeding. Extreme cases of placenta accreta, in which the placenta begins to invade the bladder or nearby structures (known as placenta percreta) can present with bladder or pelvic pain, or occasionally with blood in the urine.

During a normal delivery, the placenta detaches from the uterus during the last stage of labor. This can also be referred to as the “afterbirth.” With accreta, the placenta is tightly attached to the uterine wall and does not separate naturally during delivery. This causes several complications for the baby and mother.

Headline

It’s important to consult with a specialist who has experience with placenta accreta to help manage and care for your pregnancy. If possible, the delivery should occur at a specialized center where the staff is well trained and has experience with accreta deliveries, and where you will have access to a multidisciplinary team of specialists as needed.

Our team of maternal-fetal medicine specialists (high risk obstetricians), radiologists, surgeons, nurses, and other medical specialists provide supportive and compassionate care before, during, and after pregnancy for women who have or are at risk of having pregnancy complications. This care includes counseling, evaluation, and medical and surgical care.

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